结肠癌D3清扫术后乳糜漏的危险因素分析

目的研究结肠癌D3清扫术后腹腔乳糜漏的有关危险因素。方法 回顾性分析行结肠癌D3清扫术后腹腔乳糜漏56例患者的临床资料做为实验组;并选取同期行相同手术未发生乳糜漏的769例患者作为对照组进行对比分析, 对选取有可能影响乳糜漏的相关因素进行单因素分析与Logistic回归分析。结果 所选的14个可能与乳糜漏相关的因素中, 低蛋白血症、肿瘤部位、淋巴结清扫数目与术后发生乳糜漏有关, 差异具有统计学意义(P＜0.05);而年龄、性别、手术时间、手术方式、术中出血量、合并糖尿病、术前肠梗阻、术前行新辅助化疗、肿瘤大小、肿瘤浸润深度、淋巴结转移与术后乳糜漏无关(P＞0.05)。Logistic回归分析显示:低蛋白血症、淋巴结清扫数目和肿瘤部位是结肠癌D3清扫术后乳糜漏的独立危险因素。结论 低蛋白血症、肿瘤部位和淋巴结清扫数目是结肠癌D3清扫术后乳糜漏的独立危险因素, 术后腹腔乳糜漏积极保守治疗有效。

Risk factors of the chylous fistula after radical resection of colon carcinoma plus D3 lymph node dissection

Objective To investigate risk factors of the chylous fistula after radical resection of colon carcinoma plus D3 lymph node dissection and its prevention.Methods Clinical data of 56 patients with the chylous fistula after radical resection of colon carcinoma plus D3 lymph node dissection was analyzed retrospectively as the observe group, and compared with the 769 patients without the chylous fistula after the same operation during the same time as the control group.The possible influencing factors of the chylous fistula were analyzed by single factor and logistic regression analysis.Results All 14 selected factors related with the chylous fistula, including anaemia or lower proteinemia, lesion site and lymph node dissection number were related with the chylous fistula.The statistical analysis showed that the difference was statistical significant(P＜0.05).Sex, age, diabetes, intestinal obstruction before operation, neo-adjuvant chemotherapy before operation, tumor size, depth of invasion, lymph node metastasis, operation method, blood loss during surgery, operation Method and operating time had no correlation with the chylous fistula(P＞0.05);Non-conditional multivariate analysis showed that anaemia or lower proteinemia, lesion site and lymph node dissection number were significant related with the chylous fistula as dependent risk factors.Conclusion Anaemia or lower proteinemia, lesion site and lymph node dissection number were significantly related with the chylous fistula as dependent risk factors.Radical resection of right-colon carcinoma plus D3 lymph node dissection is associated with higher risk for chyle leak.Conservative treatment is effective in early stage of chyle leak after radical resection of colon carcinoma plus D3 lymph node dissection.